Self-reported incidence of verbal and physical violence against emergency medical services (EMS) personnel in Singapore

Aggressive Behavior Risk Assessment Tool for Emergency Medical Services

Objectives

Emergency medical services (EMS) clinicians are at risk of on-the-job violence that can result in serious injuries. A majority of such violence is associated with underlying behavioral health emergencies. However, no simple screening tools have been validated for use in prehospital settings. This study aimed to examine the utility of the 7-item Aggressive Behavior Risk Assessment Tool for Emergency Departments (ABRAT-ED) modified for prehospital settings in identifying patients at risk for violence.

Methods

This prospective study included adult and pediatric patients aged ≥10 years transported by 2 private EMS agencies between March 11 and April 21, 2024. EMS clinicians completed the modified ABRAT-ED before initiating transport and captured any subsequent physical assault, physical threat, or sexual harassment using the Violent Event Severity Tool. Logistic regression and receiver operating characteristics (ROC) analysis were performed.

Results

Of 11,292 EMS dispatches, 9,024 patients were evaluable, and 105 had ≥1 violent event (1.16 %). The logistic regression model resulted in a 3-item ABRAT-EMS, including agitation, confusion, and aggressive/threatening behaviors. ROC analysis showed the area under the curve of 0.89 (95% CI, 0.85-0.94; P < .001). At the cutoff score of 1, the sensitivity and specificity were 82.9% (95% CI, 74.0%-89.3%) and 88.1% (95% CI, 87.4%-88.8%), respectively, indicating that the ABRAT-EMS would correctly identify 82.9% of violent patients while correctly identifying 88.1% of nonviolent patients.

Conclusion

The ABRAT-EMS is a brief 3-item checklist with satisfactory sensitivity and specificity for identifying potentially violent patients during EMS encounters. The use of ABRAT-EMS can help EMS clinicians identify potentially violent patients and allow the implementation of proactive, targeted violence prevention measures.

The moderation effect of mentalization in the relationship between impulsiveness and aggressive behavior

Aggressive behavior is a growing problem across many contexts. Thus, searching for its predictors is important. The aim of the current study was to analyze the moderator effect of mentalization in the relationship between impulsiveness and both verbal and physical aggressive behavior, using a sample of 583 participants gathered from the general Spanish population (MAge  = 34.60, SDAge  = 12.99). In our sample, 182 were male and 401 were female. The results showed significant bivariate relationships among aggression, impulsiveness, and mentalization. Moderation structural equation modeling (MSEM) showed a significant moderation effect, so whereas the value of mentalization is not relevant in cases of people with low impulsiveness, high mentalization abilities allow those people with high impulsiveness to behave less aggressively than people with high impulsiveness and low mentalization abilities. Practical implications and limitations of the study are discussed.

Critical incident experiences, related stress and support among Finnish paramedics: A cross-sectional survey study

INTRODUCTION

Paramedics work in diverse, demanding prehospital settings. We examined the prevalence of critical incident (CI) experiences, critical incident stress (CI-S), and CI-S association with the intention to leave the paramedic profession, as well as the needed and received support for CI-S among Finnish paramedics.

METHODS

In 2022, n = 427 Finnish paramedics from eight different organizations responded to a modified Emergency Medical Services (EMS) Critical Incident Stress Inventory and reported the CIs experienced during their EMS careers and the related CI-S within the last six months. Statistical analyses were stratified by gender.

RESULTS

All the listed 31 CIs had been experienced by the Finnish paramedics, and the experiences increased with work experience, especially among men. CI-S had wide variation, seemed to increase with work experience, and was mainly not associated with the intention to leave the profession. Support for coping with CI-S was most often received from colleagues, then from family members, friends, and to some extent, managers.

CONCLUSIONS

Because of the inherent nature of the demands and features of the paramedic work, experiencing CIs is unavoidable. Examining effective coping strategies, organizational support, and managerial practices are needed to support highly skilled paramedics in their demanding work.

Perception and Practice of Workplace Violence Prevention and Its Associated Factors among Employers at Healthcare Facilities in Melaka, Malaysia

Workplace violence (WPV) is a major public health concern, especially among healthcare workers. There is a negative perception and poor practice of healthcare employers towards WPV prevention. This study aims to determine the perception and practice towards WPV prevention and its associated factors among healthcare employers in Melaka, Malaysia. A cross-sectional study was conducted by recruiting 162 healthcare employers, using a validated questionnaire and utilised linear regression analysis. The participants had a mean percentage of 67.2% for perception and 80% for practice towards WPV prevention. The perception towards WPV prevention is associated with the following characteristics: female (adjusted ß = -3.95; 95% CI: -7.81, -0.09; p = 0.045), Indian ethnicity (adjusted ß = 16.04; 95% CI: 2.34, 29.74; p = 0.022), other ethnicities (adjusted ß = 25.71; 95% CI: 8.94, 42.47; p = 0.003), degree holder (adjusted ß = 4.35; 95% CI: 0.15, 8.54; p = 0.042), masters holder (adjusted ß = 7.63; 95% CI: 1.11, 14.14; p = 0.022), and enough funds (adjusted ß = -5.46; 95% CI: -9.25, -1.67; p = 0.005). Meanwhile, the practice towards WPV prevention is significantly associated with Chinese ethnicity (adjusted ß = -9.25; 95% CI: -18.36, -0.14; p = 0.047), Indian ethnicity (adjusted ß = -14.97; 95% CI: -29.48, -0.46; p = 0.043), other ethnicities (adjusted ß = 23.55; 95% CI: 5.59, 41.51; p = 0.011), degree holder (adjusted ß = -4.41; 95% CI: -8.67, -0.14; p = 0.043), and availability of standard operating procedure for reporting WPV (adjusted ß = 6.07; 95% CI: 1.58, 10.57; p = 0.008). The high perception and practice towards WPV prevention and its associated factors among healthcare employers provide evidence-based input to improve the existing measures for WPV prevention.

Nationwide Alcohol-related visits In Singapore's Emergency departments (NAISE): A retrospective population-level study from 2007 to 2016

INTRODUCTION

Excessive alcohol consumption is associated with increased morbidity and mortality, and its societal impact is substantial. The Nationwide Alcohol-related visits In Singapore Emergency departments study aims to characterise trends in ED visits involving acute and chronic alcohol consumption between 2007 and 2016.

METHODS

Data from the Singapore Ministry of Health, comprising all ED visits in Singapore from 2007 to 2016, were used. The data were aggregated by year and analysed for changes in prevalence and rates of ED visits for acute and chronic alcohol consumption, broken down by age, gender and ethnicity.

RESULTS

Over the study period, the number of ED visits involving alcohol consumption increased 98.3%, from 2236 in 2007 to 4433 in 2016. During the same period, the rate per 100 000 population increased 62.4% from 48.7 to 79.1, and total ED-related costs rose by 140%, from 528 680 to 1 269 638 SGD. The increase in alcohol-related visits rates and costs was higher than non-alcohol-related visits rates and costs, which increased by 12.1% and 115% respectively. While trends in acute and chronic alcohol-related ED visits stayed stable amongst women, they rose substantially in men. Older men aged 50-69 show the highest rates and rate of increase for both acute and chronic alcohol-related ED visits.

DISCUSSION AND CONCLUSIONS

Alcohol-related visits contributed disproportionately to the increasing number of ED visits in Singapore between 2007 and 2016. Older men form the demographic with the highest rates and increase in rates of alcohol-related ED visits and form a potential group for targeted intervention.

Self-Reported Violence Experienced by Swiss Prehospital Emergency Care Providers

Background

Workplace violence is a serious and increasing problem in health care. Nevertheless, only few studies were carried out concerning this topic and then mainly in English-speaking countries. The objectives were to describe the acts of violence experienced by prehospital emergency care providers (PECPs) in the western part of Switzerland between January and December 2016 and to assess the consequences for subsequent PECPs behaviors.

Methods

An observational cross-sectional study, carried out using an online survey, has been sent to all 416 PECPs in the Canton of Vaud, in the western, French-speaking, part of Switzerland. The survey contained items of demographic data and items to assess the type and consequence of violence sustained. This was classified as five types: verbal assault, intimidation, physical assault, sexual harassment, and sexual assault.

Results

273 (65.6%) PECPs participated in the survey. During 2016, workplace violence was reported by 229 survey participants (83.9%). Most declared to be the victim of such violence between one and three times during the year. In all cases of violence described, the patient and/or a relative initiated aggressive behavior in 96% of cases. Verbal assaults were the most common (99.2% of all acts), followed by intimidation (72.8%), physical assault (69.6%), and sexual harassment (16.3%). Concerning physical assault, PECPs were predominantly victims of spitting and/or jostling (50%). After a violent event, in 50% of cases, the PECPs modified their behavior owing to the experience of workplace violence; 82% now wear protective vests, and 16% carry weapons for self-defense, such as pepper sprays. Seventy-five percent changed their intervention strategies, acting more carefully and using verbal de-escalation techniques or physical restraints for violent patients.

Conclusions

Workplace violence is frequent and has significant consequences for PECPs. In order to increase their own security, they increased their protection. These results illustrate their feelings of insecurity, which may have deleterious effects on work satisfaction and motivation. Trial Registration. Our article does not report the results of a health care intervention on human participants.

Workplace violence towards emergency nurses: A cross-sectional multicenter study

BACKGROUND

Workplace violence (WPV) against nurses continues to be a challenge within healthcare systems worldwide. Quantifying the burden of WPV in emergency departments will inform the design of appropriate interventions. This study aimed to determine the prevalence, pattern and factors associated with WPV among emergency nurses working in Saudi Arabia.

METHODS

A multicenter descriptive online survey was conducted using a standardized self-administered questionnaire. Emergency nurses working in public hospitals in the country were invited to participate. Data were analyzed with descriptive statistics and multivariate logistic regression.

RESULTS

The study recruited 849 emergency nurses, most (73.7%) had experienced WPV in the past two years; 47.4% experienced physical violence and 94.3% experienced non-physical violence. Most exposures to WPV occurred during the afternoon shifts (70.8%), and mainly perpetrated by family members or relatives of the patients (88.3%).

CONCLUSION

WPV encountered by emergency nurses in Saudi Arabia is alarmingly high, and underreported by the affected nurses. Increased workload, inadequate staffing levels, poorly enforced visitor policy, unmet expectations, and a lack of clarity in reporting were the most frequent causes of WPV. There is a need to reassess the current occupational safety measures in the emergency departments in the country.